Meditation and the Art of Diabetes Management

In our fast-paced society, the idea of taking 20 minutes a day to sit quietly and focus on your breathing may sound like a novel concept. In fact, the practice of meditation is thousands of years old and is still practiced today by people of many cultures all around the world. Recent research studies have shown that meditation not only has the ability to calm and focus the mind, but that it benefits the body as well. For example, meditation has been shown to reduce such risk factors for cardiovascular disease as high blood pressure.

Many people turn to meditation to help deal with a specific health problem such as chronic pain or to get through a time of personal crisis. Others are simply looking for a better way to deal with regular life stresses. You may find yourself interested in trying meditation for one of these reasons, but you may be worried that you won’t have the time or drive to commit to practicing it regularly. I have been practicing meditation for the past 34 years and been teaching it for the past nine years — a long time. While attending a conference on Buddhism and psychotherapy last year, though, I was reminded all over again that the value of meditation is not dependent on how much you do or how committed you are. Rather, the value is measured in how you are able to use it and if it makes a difference in your life. As you learn about meditation, don’t be frightened off by thinking you must commit yourself to a whole new lifestyle. Meditation is just another good tool you can use to help manage your life and your diabetes.

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Forms of meditation

There are several forms of meditation, each of which is performed a little differently. In mindfulness meditation, for instance, you focus on your breathing as a means of achieving moment-to-moment awareness. I learned this form of meditation in a class at a junior college in 1970, mostly as a means of relaxing. My teacher also helped me understand that the practice of psychotherapy begins with being mindfully present with each patient.

The following year, I was introduced to transcendental meditation, which is the most common form of meditation practiced in the Western world. This form of meditation involves a mantra, which is a word or phrase that a person repeats in his mind to help himself focus. When learning this technique I was told I had to commit myself to not revealing my mantra to anyone else, ever. In case my teacher is reading this article, to this day I have never told anyone.

I have also tried focused awareness meditation, staring with half-open eyes at a candle or some other object while tuning in to my breathing. I have done meditation while walking, eating, lying down, on a cushion, on the floor, in a chair, standing, outside, inside, in a group, alone, in public, and with squirrels. (The latter is not a form of meditation; the squirrels just showed up while I was sitting outside.)

In other words, meditation is not just a technique practiced formally in a temple or a church. Instead, it is a practice that can be done in many ways and in many settings to help your mind and body relax. It can also help you develop more personal insight or, in some cases, help you develop your spiritual life.

Some people are reluctant to try meditation because they believe it is always religious or think that a person is not in control of himself while meditating. There are indeed religious practices that use meditation as a means of enhancing the practitioner’s spirituality; Zen Buddhism, for instance, has a tradition of meditation that plays a central role in spiritual growth. Some Christian practices also use meditation as a means of bringing one closer to God, and it is used in the mystical Jewish tradition of Cabala. Any practice of calming and focusing the mind with the intention of seeking a relationship with a higher being or enhancing one’s consciousness is a form of meditation. However, meditation can be, and often is, performed to enhance physical health and well-being outside the context of religion. In addition, all meditation is engaged in intentionally and is not something that can be done to a person. It cannot be used to brainwash or secretly manipulate someone into changing their beliefs or doing something outside their value system; in other words, meditation is entirely within the control of the person practicing it.

Mindfulness meditation

Several years ago I attended a conference where Jon Kabat-Zinn, PhD, a mind–body medicine specialist and Professor of Medicine Emeritus at the University of Massachusetts Medical School, spoke about the research he had conducted using a program called the Mindfulness-Based Stress Reduction and Relaxation Program. I quickly realized that this was the type of meditation I had learned some 25 years earlier. This time, however, there was research backing what most of us who practice meditation know from experience: that meditation helps you to live in a more relaxed manner. I eventually took a weeklong class from Jon Kabat-Zinn and Saki Santorelli, EdD, the director of the Stress Reduction Clinic at the University of Massachusetts Memorial Medical Center. After completing this program, I joined with others and started a program at the medical facility where I worked. I have been teaching mindfulness-based meditation ever since.

Mindfulness meditation is the practice of working with concentrated awareness to live each moment fully. In other words, the point of this type of meditation is to learn to live your life more fully, not to sit in the lotus position for hours a day. It can also help you live with diabetes more fully. By developing an accepting attitude and fuller awareness of how your life and the management of your diabetes interact, you can learn to respond thoughtfully, rather than just react, when challenging situations arise.

The formal practice of mindfulness meditation is usually done sitting with your back straight, either in a chair or on the floor using a cushion called a zafu for support. (It can also be done lying on the floor with a technique called the body scan, in which a person moves his focus throughout his body, concentrating on any areas that cause him pain or suffering.) No matter which position you choose, you begin the process of meditation by focusing on your breathing. As you try to focus, however, you may become distracted by thoughts, sounds, or even odors. It is helpful to treat these distractions as though you were an objective observer. Normally, you might think, “I hate that sound; it’s really disturbing me. Can’t they be quiet? That makes me so mad.” As an objective observer, however, you might say to yourself, “That is the sound of someone’s voice,” then return your awareness to your breathing. Being an objective observer means that you can notice things without becoming upset, so you stay calm and in the present moment.

Does this sound too simple or boring? Stop reading and give it a try right now. See how long you are able to focus your awareness on your breath. This is the task and challenge of beginning mindfulness meditation. After working on this task, you will come to understand that meditation is not just about paying attention to your breath (which can’t be done for long, anyway). Rather, it is about maintaining your awareness of the present moment so that you recognize when your thoughts have drifted and are able to come back to the present again by focusing on your breathing. Your breathing acts as an anchor to the present moment and helps you maintain a peaceful state of mind.

Being in the present moment

Being in the present moment is important because it is the only time we can do anything about. In caring for your diabetes, the future is important, too, in that you need to plan and anticipate what you will do later in the day. However, now is the only time you can do that planning and preparation. Thinking too much about the future can create worry or anxiety over what might happen — worry that may keep you from experiencing the present fully. In meditation, focusing on the present moment is practice for living in the present. It is through this practice at not getting caught up in future anxieties that we can learn to maintain a sense of calm.

Being in the present can also help keep you from getting hung up on past events. We all know someone who is always reminiscing, either grieving their losses or remembering the good old days. Either of these practices can lead to extreme feelings of sadness or even depression over what has been lost or guilt over what should have been done. Unfortunately, there is nothing you can do to change the past or recapture it; you can only apply its lessons to life now.

With diabetes, it is important to learn from the past, so as to not repeat the same mistakes. Living in the present doesn’t mean you should ignore the lessons of the past; rather, it means that you can spare yourself significant sadness and guilt by letting go of it and living in the now. Freedom from both worrying about the future and remaining overly attached to the past is a key goal of mindfulness meditation, which helps a person practice staying fully present for whatever he is experiencing now.

Getting started with meditation

Mindfulness meditation can be learned through reading books and listening to CDs or tapes (see “Meditation Resources” for some suggestions), but starting it alone would require a great deal of focus to stay committed to the practice. I believe that the most effective means of learning this form of meditation is to seek out a class or a teacher in your area. These classes are often offered through hospitals, clinics, and meditation centers; some churches and Buddhist centers may also offer programs. Classes may be called “mindfulness meditation” or possibly “Mindfulness-Based Stress Reduction and Relaxation Program.” In a class, you will learn the basics of dealing with stress through the use of meditation practices, group support, and brief lectures. This type of class helps when barriers, such as difficulty staying focused, arise or when questions about what is “normal” to experience while meditating come up.

I mentioned transcendental meditation as another type of meditation that I learned early in my meditation practice. I used transcendental meditation for quite some time and found it to be useful, particularly in times when I was tired and needed more rest. I found it helpful to get a different type of rest than sleep provides; in 20 minutes, I could feel as though I’d had a two-hour nap. If you are interested in this form of meditation but don’t want to seek out formal teaching, you can try the following exercise, which may help you with getting more rest when you need it. First, create your own mantra (a word or phrase that is repeated over and over to help calm your mind). An example of a mantra is the word “one” or a phrase such as “peaceful mind.” Sit in a comfortable position with your spine straight and eyes closed, and repeat your mantra for the next 10 minutes. If this is enjoyable, do it daily for a week, then increase it to 15 minutes, and the next week go up to 20. Try to meditate at the same time each day if you can; while not essential, such regularity will help you build meditation into your daily routine.

The two main stumbling blocks in transcendental meditation are falling asleep and drifting. (In fact, these are common barriers for all types of meditation.) It is not unusual for people to fall asleep when they close their eyes and relax; this usually means that you needed the sleep. So set an egg timer or your watch alarm so you will know when your time is up. Drifting, or daydreaming, is an-other issue. You may enjoy the drifting feeling, but to meditate and gain the benefits of meditation, training yourself to focus requires some concentration. When you notice yourself drifting, come back to your mantra and begin repeating it to yourself again. Mastering this process takes practice, and it is normal for most of us to have our minds wander, so don’t be surprised when it happens; just repeat your mantra.

Why meditate if you have diabetes?

Having practiced and taught meditation, I could go on at length about the physical and mental benefits of meditating regularly. I could include things like the development of an accepting mind, the ability to learn to let go of stressful events, the understanding of how to pick one’s battles, and the development of a sense of discipline that helps in everyday life. But I’ll keep it brief.

Meditation will help you to relax in a new way and give you some fresh tools for dealing with stress. Life stress is a big issue for all of us. For those who have diabetes, stress presents at least two problems: The direct effect of stress raises blood glucose levels, and we are most likely to engage in behaviors that are not good for our health when we are stressed. We may tend to eat more high-carbohydrate foods, or sit on the couch and watch TV instead of exercising. When stressed, we tend to become less disciplined and more self-indulgent.

Research studies suggest that practicing meditation regularly helps people reduce their bodies’ responses to stress by lowering blood pressure, slowing heart rate, reducing oxygen intake, and changing the brain waves to a more relaxed state. Moderating the stress response is also likely to lower blood glucose levels. Regular meditation builds skills in responding mindfully, meaning that you will learn how to take your time to think through your actions before acting. As you practice meditation regularly, you will begin to notice that the decisions you make are more thoughtful. The likelihood of grabbing for chips or ice cream becomes lower, and the possibility of going for a walk increases. In other words, your ability to handle stress will be strengthened by good decisions and you will be capable of relaxing without engaging in negative behaviors.

As a therapist who works primarily with people with diabetes, I have found that those who have a deeper understanding of themselves and have the ability to cope well with stressful life events simply live better with diabetes, both in terms of diabetes control and general quality of life. Diabetes self-care and meditation are both practices that require discipline and commitment. But the payoffs are tremendous for practicing them together. Reduced stress, better diabetes control, lower blood pressure, lower blood glucose levels, greater self-awareness, better relationships, improved focus in other areas of your life, and less depression and anxiety are all potential benefits of including meditation in your routine. Making meditation a regular part of your diabetes management will enhance both your attitude and control.

Joseph Nelson is a psychotherapist in private practice in Minnesota.

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